title: Improving breast cancer detection using ultrasonography in asymptomatic women with non-fatty breast density.
abstract: BACKGROUND
  Mammography (MX) is a reliable modality for detection of breast cancer in asymptomatic women. Use of additional whole breast ultrasonography (US) for breast cancer screening is widely recognized, in particular in women with dense breast parenchyma.
  
  
  OBJECTIVE
  To determine the subgroup of women, according to breast density and age, who receive most benefit from US following MX for detection of breast cancer in an asymptomatic condition.
  
  
  METHODS
  The study was conducted in asymptomatic women who had non-fatty breast parenchyma using MX and US during January 2006 and December 2007. Mammographic breast density was classified as recommended by ACR BI-RADS lexicon. Non-fatty breast referred to D2, D3, and D4. US was performed by the same radiologists who interpreted MX with a handheld machine during the same visit. Data on demographics, cancer detection rate (CDR), and incremental cancer detection rate (ICDR) were analyzed using 95% confident interval (CI).
  
  
  RESULTS
  Of 14,483 breast cancer screenings in women who had non-fatty breast density, 115 cancers were documented. The mean age of cancer patients was 49.6 years. Of 115 cancers, 105 were evidenced on images (31 with MX alone, 19 with US alone, and 55 with both MX and US). Overall CDR was 7.9 per 1000 examination (95% CI, 6.5-9.5). CDR for MX only (MX-CDR) was 6.5 per 1000 examinations (95% CI, 5.2-7.9). Additional US could significantly improve CDR (P < 0.001; 95% CI, 0.9-2.2); US-ICDR was 1.4 per 1000 examinations. According to age group, the group of 40-59 years had statistically significant improvement of ICDR (P < 0.001). The ICDR was highest in D4 breast density (D4) (US-ICDR = 2.5 per 1000 examinations).
  
  
  CONCLUSIONS
  Use of US adjunct to MX for detection of breast cancer in asymptomatic non-fatty, average-risk women for detection of breast cancer is a promising diagnostic procedure. A significant benefit was documented, in particular, in women aged 40-59 years old, and in women with D4 breast density.
authors.affiliation: Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Pornpim
authors.initials: P
authors.lastname: Korpraphong
authors.affiliation: Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Panida
authors.initials: P
authors.lastname: Limsuwarn
authors.affiliation: Thanyarak Breast Imaging Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Woranuj
authors.initials: W
authors.lastname: Tangcharoensathien
authors.affiliation: Thanyarak Breast Imaging Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Tamnit
authors.initials: T
authors.lastname: Ansusingha
authors.affiliation: Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Kullathorn
authors.initials: K
authors.lastname: Thephamongkhol
authors.affiliation: Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand suebwong.chu@mahidol.ac.th.
authors.forename: Suebwong
authors.initials: S
authors.lastname: Chuthapisith
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Asymptomatic; breast cancer; mammography; non-fatty breast density; ultrasonography